Application for Admission

RED DEER COLLEGE 100 College Blvd., APPLICATION FOR ADMISSION Box 5005 Red Deer, Alberta T4N 5H5 FOR OFFICE USE ONLY NON-REFUNDABLE APPLICATION FEE ENCLOSED Telephone: 403.342.3400 Fax: 403.357.3660 I.D. NUMBER RECEIPT DATE E-mail: [email protected] Home Page: http://www.rdc.ab.ca FALL (Sept. – Dec.) In which term do you wish to begin attendance? SPRING (May – June) WINTER (Jan. – April) SUMMER (July – Aug.) PREVIOUS APPLICATION I have previously applied to Red Deer College YES NO RDC ID # Non-refundable application fee enclosed $100 Domestic Student $200 International Student Method of payment: Apply on line at www.rdc.ab.ca/apply or pay in person at the Cashier Office with cash, cheque, money order, debit or credit card or mail in your application with a cheque to the address above. PERSONAL INFORMATION (please print clearly AND enter your full legal name) NAME LEGAL LAST NAME (SURNAME) Red Deer College recognizes and welcomes the autonomy of individuals of all genders to be referred to in a way that reflects their identity. All LEGAL FIRST NAME (GIVEN NAME) applicants are welcome to signify the gender that they identify with. LEGAL MIDDLE NAME Please check if you do GENDER Male Female Prefer not to identify not have a middle name. PREFERRED FIRST NAME BIRTHDATE (YYYY/MM/DD) LIST ALL FORMER NAMES (if applicable, e.g., maiden name) CITIZENSHIP PERMANENT ADDRESS FIRST LANGUAGE SPOKEN STREET, AVENUE, P.O. BOX NUMBER What is your status, per Citizenship and Immigration Canada rules CITY OR TOWN PROVINCE Canadian Citizen Refugee Student Permit Permanent Resident/Landed Immigrant POSTAL CODE COUNTRY If not Canadian – Date of entry to Canada (YYYY/MM) E-MAIL ADDRESS Country of Citizenship HOME TELEPHONE CELLPHONE Declaring your Aboriginal heritage will assist in providing services, MAILING ADDRESS (if different than above) developing programs and offering events for Aboriginal learners. Status Indian/ Non-Status STREET, AVENUE, P.O. BOX NUMBER Métis Inuit First Nations Indian/First Nations CITY OR TOWN PROVINCE POSTAL CODE COUNTRY OTHER ATHLETICS - Do you intend to try out for intercollegiate athletic E-MAIL ADDRESS competition? YES NO If yes, which sport? HOME TELEPHONE CELLPHONE MUSIC Do you intend to try out for a Music Ensemble? (Symphonic Winds, Big Band, Choir, etc.) ALTERNATE CONTACT YES NO If yes, which ensemble? LAST NAME FIRST NAME DISABILITIES If you have special needs related to a disability, would you like the HOME TELEPHONE CELLPHONE Disability Services Coordinator to contact you? YES NO RELATIONSHIP TO APPLICANT ACADEMIC INFORMATION LAST HIGH SCHOOL ATTENDED OR ATTENDING NOW Alberta Student Number - ASN NAME CITY PROVINCE COUNTRY (if applicable) ARE YOU ATTENDING HIGH SCHOOL NOW? Will you or do you have a high Y Y Y Y / M M school diploma? YES If YES, what grade? When will you finish? YES NO NO If NO, last grade completed When did you finish? Last year of high school courses which you have completed or will complete prior to attending RED DEER COLLEGE. Please indicate course level(s). Only International Students are required to provide the Grade Percentage %. SUBJECT LEVEL % SUBJECT LEVEL % SUBJECT LEVEL % SUBJECT LEVEL % List the highest levels of Math, e.g., ART DRAMA PHYS. ED. 30-1, 30-2, Applied, etc. BIOLOGY ENGLISH PHYSICS MATH FRENCH CHEMISTRY (Or approved SCIENCE MATH second language) COMPUTER SOCIAL MUSIC MATH SCIENCE STUDIES International Applicants Score: TOEFL _____ IELTS _____ CAEL _____ MELAB _____ PTE_____ POST SECONDARY EDUCATION Attach list if more than two. Attached Name of University/College/Technical Institute LOCATION Last Attended Length of Certificate/Diploma Obtained or (List MOST RECENT first) City / Province Year / Month Program Number of Years Completed PROGRAM CHOICE INFORMATION st 1 Program Choice 2nd Program Choice MAJOR (if applicable) MAJOR (if applicable) Full-Time Part-Time Distance On Campus Full-Time Part-Time Distance On Campus If you do not gain admission to your program of choice, would you like to be considered for the Open Studies Program? YES NO Note: If you are accepted into your first program of choice, your application for your second choice will not be processed. Bachelor of Education Secondary and Music Diploma applicants MUST declare a major. Please see a full list of available majors at www.rdc.ab.ca/programs/academic-calendar Visiting Student (Specify: University/College – Letter of Permission required) : DECLARATION OF APPLICANT The personal information on this form is collected under the authority of the Post-secondary Learning Act of Alberta, the Freedom of Information and Protection of Privacy Act of Alberta (FOIP), the Statistics Act of Canada and the Income Tax Act of Canada. The information will be protected in compliance with FOIP used by the Office of the Registrar to determine your eligibility for admission and registration in programs; collecting transcripts; administering records, scholarships and awards; providing student services; and for alumni relations and fundraising. The personal information may be disclosed to academic and administrative units for College planning and research activities; federal and provincial agencies for reporting requirements; contracted or public health care providers, including collaborative educational, funding, and workplace agencies as required; and the Student’s Association of Red Deer College through data sharing agreements. The information will be retained in accordance with approved Information Management guidelines. If you have any questions about the collection and use of this personal information, please contact the Registrar, Red Deer College, 100 College Blvd., Box 5005, Red Deer, Alberta, T4N 5H5, Telephone:403.342.3400. Declaration of aboriginal descent is self proclaimed. ALBERTA ADVANCED EDUCATION IS COLLECTING THIS PERSONAL INFORMATION PURSUANT TO SECTION 33(C) OF THE FOIP ACT AS THE INFORMATION RELATES DIRECTLY TO AND IS NECESSARY TO MEET ITS MANDATE AND RESPONSIBILITIES TO MEASURE SYSTEM EFFECTIVENESS OVER TIME AND DEVELOP POLICIES, PROGRAMS AND SERVICES TO IMPROVE ABORIGINAL LEARNER SUCCESS. For further information or if you have questions regarding the collection activity, please contact the Office of the Director, Research Accountability and Data Collection, Alberta Advanced Education, 10155-102 Street, Edmonton AB, T5J 4L5, (780) 422-4322. If you have any questions regarding the collection activity of the post-secondary institution, please contact the Registrar of Red Deer College. I certify that the information provided is true and complete in all respects and that no information has been withheld. I understand that falsifying or omitting documents or information on this application will result in immediate and permanent dismissal from the College. Falsified documents may be referred to the appropriate authorities for prosecution of the applicant under the Criminal Code of Canada. The College reserves the right to refuse admission or cancel any admission ruling. I agree, if admitted, to comply with all College policies and understand my rights and responsibilities as a Red Deer College student. I agree, if admitted to Red Deer College, to comply with all rules and regulations of the College. SIGNATURE OF APPLICANT DATE OF APPLICATION APPLICATION FOR ADMISSION Page 2 11/16 .

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